Healthcare Provider Details

I. General information

NPI: 1861888711
Provider Name (Legal Business Name): THERESE FEDEROWICZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 VESTAL PKWY E
VESTAL NY
13850-3556
US

IV. Provider business mailing address

33 LEWIS RD
BINGHAMTON NY
13905-1048
US

V. Phone/Fax

Practice location:
  • Phone: 607-240-2885
  • Fax:
Mailing address:
  • Phone: 607-729-8156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number305233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: